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A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purposes of this amendment is to increase reimbursement rates for Nursing Facilities during the COVID-19 state of emergency for all costs associated with staffing, supplies, social distancing standards, cleaning fees, etc. AL noted that this increase equates to approx. $20 per diem rate add-on payment for all NF's.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purposes of this amendment is to remove the requirement for Prior Authorizations for service destinations and non-emergency services for ambulances during the COVID-19 emergency.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. In this amendment Alabama elects to suspend Medicaid copayments for all services for all Medicaid beneficiaries during the time of the Public Health emergency and to utilize telehealth for some Medicaid services.
Summary: Updates the State’s Asset Verification System (AVS) reflecting the State’s decision to go from using a contractor to build the system to joining a consortium to develop an Asset Verification System
Summary: Allows the state to comply with the Medicaid Drug Utilization Review (DUR) provisions
included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and
Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).
Summary: Proposes to update the payment rates for nursing facility residents to provide for reimbursement when a resident of a Disaster Struck Nursing Facility must be temporarily evacuated to another facility due to a disaster for a period of up to thirty (30) days.
Summary: Proposes to apply the reimbursement methodology for inpatient and outpatient hospital services for State fiscal year 2020 in a manner consistent with that used in fiscal year 2019
Summary: Updates the physician office and outpatient fee schedule to increase the rates for select Long-Acting Reversible Contraceptive (LARCs) Devices and updates the pricing methodology for specified codes on the physician-surgery fee schedule for manually priced to a fixed fee at 57.5% of Medicare
Summary: Updates the physician office and outpatient fee schedule by restructuring the payment methodology for pediatric medical providers who apply fluoride varnish to the teeth of Medicaid members and expands the age range of individuals who can receive an oral assessment and/or application of fluoride varnish by a pediatric medical provider.